A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus

Size: px

Start display at page:

Download "A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus"

Loraine Garrett
5 years ago
Views:

1 J. Fd Hyg. Safety Vol. 25, No. 2, pp. 133~142 (2010),QWTPCN QH (QQF *[IKGPG CPF 5CHGV[ Available online at ò ù ô Ð 1 ÂÞ 1 Â ý 2 * 1 w œ w, 2 w œw A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus Jong-Gyu Kim 1, Jeong-Yeong Park, and Joong-Soon Kim 2 * 1 Department of Public Health, Keimyung University, Daegu , Korea 2 Department of Industrial and Management Engineering, Keimyung University, Daegu , Korea (Received February 5, 2010/Revised March 19, 2010/Accepted May 1, 2010) ABSTRACT This study was performed to investigate awareness of hand washing, hand washing behavior, and the levels of indicator microorganisms on hands of food handlers who work in the food court and cafeteria of a university campus. The three methods used were questionnaire survey by interview, direct observation in restrooms, and microbiological examination according to the Food Code of Korea. A positive attitude toward hand washing compliance was reported by the responded food handlers; however, improper hand washing and poor hand hygiene of the food handlers were recognized by the unnoticed direct observation. Significant differences were found between the questionnaire survey and the direct observation (p < 0.05) in hand washing compliance after using the toilet, duration of hand washing, use of hand washing agent, washing different parts of the hands, hand-drying method, temperature of water, and method of turning off the water. Samples taken from their hands before work showed higher level of standard plate count, total and fecal coliforms, and Escherichia coli than those taken after washing with water. After washing hands with antiseptic liquid soap, the bacterial populations including Staphylococcus aureus on hands were dramatically reduced. This study indicates that there is a remarkable difference between the food handlers' awareness of hand washing and their hand washing behavior. Poor hand washing compliance and hand hygiene were indicated by the positive results of total and fecal coliforms, E. coli, and S. aureus on hands of some food handlers. The findings of this study suggest that the hand hygiene of the food handlers need to be improved. More training/education on hand washing and hand hygiene of the food handlers should be necessary. Key words: Hand hygiene, hand washing, awareness, behavior, food handlers w t w/ t l»¾ š, t ƒ w w t y w z. w t ƒ t œ w w w w w 1). t Salmonella spp., Escherichia coli, Staphylococcus aureus w, q t,», š t *Correspondence to: Joong-Soon Kim, Department of Industrial and Management Engineering, Keimyung University, Daegu , Korea Tel: , Fax: jskim@kmu.ac.kr ü w t qw 2).p t t w» y qw, w t š 3). t w w w w ú. l w t y w w t 4). p t ƒ. t t w w w t» w 5). v 133

2 134 Jong-Gyu Kim, Jeong-Yeong Park, and Joong-Soon Kim w wù ƒ» w. t, Áƒœ, máq, p w t t y t w w w e. ƒ w œ y wš w t y ù q yw» w w w ù sƒwš l w v w 6). w w jš t y q w /z v v w ùe. wr w ü (norovirus) v A(H1N1)» š z» w v w šƒ 7). w ü j- (Norwalk-like virus) w y w» w» w 8). ù v Aƒ y p» š. w, p w œ y w w. w ü { w» w / w, š t š w. ßá ù öù ò ~10 4 w ü { w 51 w. US CDC, US FDA/CFSAN «w w š9-13) w w w. ü y z»,», /,,,,,, /, š y. y w k(multiple choice)w w. z w w. ù ò ~10 4 w. w y w 39 w. ü y z» / w,, /,,,,,, /, š y. z ƒ ww, ƒ w ùkü w. 30 { w w. ù ÜôÚ w x w 51 w. Glove-Juice 14-15) w ww. ³ š ³w 0.85% NaCl 100 ml 1 w kw w z x w. x v w» š» ³» w ³w z w. w t ³ t ³, ³ ³, š w k y s ³.,, eš z, š w³ 16) z ƒ w ƒƒ w tœ 17) x x w. w³» «w 18)» ww. ³ t sq (standard plate count agar, Difco, USA) w yw d w. ³, ³ ³ z x wš y (most probable number, MPN) t mw e ùkü. ³ d (lactose broth, Difco), BGLB (brilliant green lactose bile broth, Difco), EMB (eosine methylene blue agar, Difco) mw w š, ³ ³ d EC (EC medium, Difco) w. y s ³ ww. y s ³ d w TSB (tryptic soy broth, Difco) ³ wš ùy ƒ m w (mannitol salt-egg yolk agar, Difco) w w. y s ³ x Baird-Parker agar (Difco) w 17). Ì æö Ý Ð Minitab (R) 15.1 (Minitab Inc.) w w. ƒ w w.

3 A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus 135» w z-test ww.» w chi-square test z-test ww. x w z-test (analysis of variance, ANOVA) wwš z w Tukey s multiple range test ww. ƒ α =0.05. Š Œ Þ w p Table 1. ƒ 24 (47.1%), š ƒ 27 (52.9%). 50 (31.4%)ƒ ƒ. 50 (58.3%)ƒ ƒ š, 20 (48.2%)ƒ ƒ. š (62.7%) ƒ. 1Ê5 (43.1%) ƒ ùkû. Table 1. General characteristics of the food handlers 1) Full-time worker 2) Part-time worker Characteristics Total No. (%) No. (%) No. (%) Age, years < 30 0 (0.0) 13 (48.2) 13 (25.5) (4.2) 6 (22.2) 7 (13.7) (25.0) 5 (18.5) 11 (21.6) (58.3) 2 (7.4) 16 (31.4) 60 3 (12.5) 1 (3.7) 4 (7.8) Education, years elementary school 1 (4.2) 0 (0.0) 1 (2.0) middle school 8 (33.3) 0 (0.0) 8 (15.7) high school 11 (45.8) 21 (77.8) 32 (62.7) college 4 (16.7) 6 (22.2) 10 (19.6) Work experience of food-service, years (y) < 1 3 (12.5) 13 (48.2) 16 (31.4) 1 y < 5 11 (45.8) 11 (40.7) 22 (43.1) 5 y < 10 3 (12.5) 3 (11.1) 6 (11.8) 10 y < 15 3 (12.5) 0 (0.0) 3 (5.9) 15 y < 20 1 (4.2) 0 (0.0) 1 (2.0) 20 3 (12.5) 0 (0.0) 3 (5.9) 1) Numbers of respondents: full-time worker 24, part-time worker 27 (total 51). 2) Full-time worker: person who works more than or equal to 11 hours a day. ù ( ) öù ò ŠŒ w y w k Table 2. 17ƒ y ƒ 10ƒ y z(100.0%) ƒ š, (96.1%) = /»/ É»/» š ù z, (96.1%) > yw ( ) š ù z(94.1%) > z(88.2%) > z(86.3%) > (82.4%) = š ù z(82.4%) >»e,», z(78.4%) = š»/ / š ù z(78.4%). w w»ƒ ww w y ù (74.5%), ã (72.5%), { z( š û ) (64.7%), (, )ù š ù z(56.9%), ö ù w (45.1%) ƒ û.» ( ù )»(29.4%) w ƒ ƒ û. wr z,, { z( š û ), ù, ã, (, )ù š ù z, š»/ / š ù z, w y», š»» w ƒ (p < 0.05). ù ( ò ) öù ò Ý ò ŠŒ y z» / w wš w Table 3. y z» w 51 (100.0%) š w ù, (74.4%). y z» w ƒ (p = 0.000).» 10 ~20 (33.3%) ƒ ù, y z 29 5 (72.4%) ƒ š ù 5 ~10 (27.6%). 30 (21.6%) ù, 30 (0.0%) w ùkû. w ƒ (p = 0.000). / (54.9%) ƒ w, (31.4%) w. (72.4%) ƒ ù, ù (27.6%).

4 136 Jong-Gyu Kim, Jeong-Yeong Park, and Joong-Soon Kim Table 2. The numbers and percentages of food handlers who claimed to wash their hands following particular activities: a multiplechoice questionnaire survey 1) Washing their hands: Full-time worker 2) Part-time worker Total z, p value No. (%) No. (%) No. (%) Before preparing food 24 (100.0) 25 (92.6) 49 (96.1) z = 1.47, p = After preparing food 23 (95.8) 22 (81.5) 45 (88.2) z = 1.69, p = Before eating 21 (87.5) 18 (66.7) 39 (76.5) z = 1.84, p = After eating 21 (87.5) 23 (85.2) 44 (86.3) z = 0.24, p = After taking a break 19 (79.2) 14 (51.9) 33 (64.7) z = 2.15, p = After visiting restroom 24 (100.0) 27 (100.0) 51 (100.0) After visiting outside 22 (91.7) 16 (59.3) 38 (74.5) z = 2.94, p = When changing task 20 (83.3) 17 (63.0) 37 (72.5) z = 1.70, p = After coughing/sneezing/blowing nose 20 (83.3) 20 (74.1) 40 (78.4) z = 0.82, p = After touching face, hair, or clothes 18 (75.0) 11 (40.7) 29 (56.9) z = 2.65, p = After handling raw meat/poultry, fish products, and eggs 24 (100.0) 16 (59.3) 40 (78.4) z = 4.31, p = After handling unsanitary objects such as waste/garbage/dirt 24 (100.0) 25 (92.6) 49 (96.1) z = 1.47, p = Before putting on gloves/when changing gloves 15 (62.5) 8 (29.6) 23 (45.1) z = 2.49, p = When hands/gloves are contaminated 21 (87.5) 21 (77.8) 42 (82.4) z = 0.93, p = Periodically 4 (16.7) 11 (40.7) 15 (29.4) z = 1.98, p = After handling money 20 (83.3) 22 (81.5) 42 (82.4) z = 0.17, p = Others (after contact with chemicals) 22 (91.7) 26 (96.3) 48 (94.1) z = 0.69, p = ) Numbers of respondents: full-time worker 24, part-time worker 27 (total 51). 2) Full-time worker: person who works more than or equal to 11 hours a day. w w. / w ƒ (p = 0.000). (3.9%)ù (2.0%) w. ù w (100.0%). w. ( ƒ, m,, ) (52.9%) ƒ ù, (6.9%) w. (41.4%) ƒ ƒ š, (34.5%). (qäe¾ ) (2.0%) ù w. w ƒ Table 3. Comparison of the results of questionnaire survey and direct observation on the hand washing awareness/behavior of food handlers Characteristics of hand washing Survey 1) Direct observation 2) No. (%) No. (%) Do hand washing after using toilet z = 3.67, p = Yes 51 (100.0) 29 (74.4) No 0 (0.0) 10 (25.6) Duration of hand washing (d) (seconds) 3) x 2 = , df = 2, p = d < 5 3 (5.9) 21 (72.4) 5 d < (21.6) 8 (27.6) 10 d < (33.3) 0 (0.0) 20 d < 30 9 (17.6) 0 (0.0) d (21.6) 0 (0.0) Use of hand washing agents 3) x 2 = , df = 2, p = Water only 2 (3.9) 8 (27.6) Water and soap 28 (54.9) 21 (72.4) Water and sanitizer 5 (9.8) 0 (0.0) Water, soap and sanitizer 16 (31.4) 0 (0.0)

5 A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus 137 Table 3. Continued Characteristics of hand washing Survey 1) Direct observation 2) No. (%) No. (%) Use of hand washing tools 3) x 2 = 1.772, df = 1, p = None 48 (94.1) 29 (100.0) Scrubbers 1 (2.0) 0 (0.0) Brush 2 (3.9) 0 (0.0) Washing parts of the hand 3) x 2 = , df = 2, p = (2.0) 0 (0.0) 2 0 (0.0) 12 (41.4) 3 4 (7.8) 10 (34.5) 4 18 (35.3) 5 (17.2) 5 27 (52.9) 2 (6.9) 6 1 (2.0) 0 (0.0) Hand-drying method 3) x 2 = 7.020, df = 2, p = Just shaking the water off 6 (11.8) 8 (27.6) Paper towel (disposable) 7 (13.7) 11 (37.9) Handkerchief 7 (13.7) 1 (3.5) Hand dryer 31 (60.8) 8 (27.6) Clothing/sanitary gown/apron 0 (0.0) 1 (3.5) Temperature of water 3) x 2 = , df = 1, p = Cold water 28 (54.9) 29 (100.0) Lukewarm water 20 (39.2) 0 (0.0) Warm water 3 (5.9) 0 (0.0) Type of water Running water 51 (100.0) 29 (100.0) Still water 0 (0.0) 0 (0.0) Method of turning off the water 3) x 2 = , df = 3, p = With bare hands: fingers 27 (52.9) 10 (34.5) With bare hands: the front of the hands 5 (9.8) 12 (41.4) With bare hands: the back of the hands 8 (15.7) 7 (24.1) With bare hands after showering the faucet 8 (15.7) 0 (0.0) After covering with paper towel 3 (5.9) 0 (0.0) Wearing personal ornaments z = 0.07, p = Yes 18 (35.3) 10 (34.5) No 33 (64.7) 19 (65.5) Washing personal ornaments z = 1.90, p = Yes 3 (16.7) 0 (0.0) No 15 (83.3) 10 (100.0) Wearing sanitary gown/apron when visiting restroom z = 6.24, p = Yes 26 (51.0) 38 (97.4) No 25 (49.0) 1 (2.6) 1) Numbers of respondents: 51. 2) Numbers of observed person: 39. 3) For the expected cell counts to be equal to or exceed 5, some classes were grouped into one class in the chi-square test. (p = 0.000). z w w (60.8%) ƒ. { / k w (37.9%)ƒ ƒ š, w w (27.6%)» l ü (27.6%)ƒ. w ƒ (p = 0.030). w (54.9%) w ƒ š,

6 138 Jong-Gyu Kim, Jeong-Yeong Park, and Joong-Soon Kim w (39.2%) w. (100.0%) w. w w ƒ (p = 0.000). w ùkû. z ƒ (52.9%) ƒ w. (41.4%) w ƒ ƒ, ƒ (34.5%) w ƒ. Õ x z (15.7%), w. w ƒ (p = 0.000). / 33 (64.7%) / w w š, / w 18 (35.3%) w 3 (16.7%). 19 (65.5%) / w, / w 10 (34.5%) w w. / w ƒ ù, w ƒ (p = 0.029). y 26 (51.0%) w y š w ù, 38 (97.4%) w y w. y w ƒ (p = 0.000). ù ÜôÚ ŠŒ» x Table 4. ³ ³, ³ ³ ƒ w.» w. s ³ w. ³, ³, ³ ³ w ƒw, ƒw w ƒ. z w w ù(p < 0.05). s ³ l, š z. w³ z s ³ sww. ³ ³ w, š z ƒƒ w ƒ (p < 0.05). ³ ³ ù z. y s ³ l, š z. ³ w, š z w ƒƒ w ƒ (p < 0.05). ³ w ƒ, š z w (p < 0.05). ³ w ù, z. ³ ù z. y s Table 4. Changes of bacterial load of hand samples of food handlers according to working period: bare hand workers Type of bacteria Before work During work After washing with water After washing with antiseptic soap F or z, p value Left hand Aerobic plate count [log (CFU/ml)] ± )a ± b ± c ND 2) F = 17.42, p = Total coliform [log (MPN/100ml)] ± a ± ab ± b ND F = 17.05, p = Fecal coliform [log (MPN/100ml)] ± ND ND ND Escherichia coli [log (MPN/100ml)] ± ND ND ND Staphylococcus aureus [log (CFU/ml)] ± ± ± ND F =2.14, p = Right hand Aerobic plate count [log (CFU/ml)] ± a ± b ± c ND F =23.64, p = Total coliform [log (MPN/100ml)] ± a ± a ± b ND F = 8.55, p = Fecal coliform [log (MPN/100ml)] ± ± ND ND z = 0.78, p = Escherichia coli [log (MPN/100ml)] ± ND ND ND Staphylococcus aureus [log (CFU/ml)] ± a ± a ± b ND F = 16.04, p = ) The value is a mean ± SE of bacterial load of positive hands. 2) not detected. Values with different superscript letters in a low are significantly different (p < 0.05).

7 A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus 139 ³,, š z w, w z w ƒ (p < 0.05). 17ƒ y 9ƒ y w ƒ, 8ƒ y ƒ» w w. ƒ š. ù wr w w / w ƒ. t» w,» û r, w wš, šƒ 19). mw ùkù» j v w ùkû. y w w»ƒ w w w y ù, ã, { z( š û ), (, )ù š ù z, w w» w ƒ û r. p» ( ù ) w ù,»» w 17ƒ y ƒ ƒ û. g (Codex Alimentarius) t wš, y w y,, w w š «wš 20). š t t y w, y z, ƒœ ù z k y, t w e w w «. wr» mw» w ƒ.» yw w ù,»ƒ w. ù m w w. y z» w 100% š w ù 2/3(74.4%). y z» / w û w.» / w û 75% š 81% šƒ 21). ù û 54.6% š 72.1% šƒ 22). w d w š w û 48% š 58% š23), w ü û 57.0% š 75.6% š24), û 37.0% š 75.6% š25), 26) w w 63% š.» / w ew š11), e w ƒ. û w (93.6%)ƒ y z» w š w ù, 16.9%» ww šƒ 11). w 27), š 21-22) w w eƒ. š m y z» / w z d j. /w, p», /,, z,, w w ƒ. ùkù» w / w ƒ ƒ 11). y z» 10 ~20 (33.3%) ƒ ù, 5 (72.4%) š ù 5 ~10 (27.6%).» w Áš w 5 û 23%, 50% šƒ 23). w 5 32% š26), w w 10 (46.4%) w» 5 ü 62.2%, 5 ~ %, š % w š ƒ 12). d w» { w w ù w ùküš. z w ùkù» w, ù» w y ƒ w. / / w 96.1%, w š 72.4%. Áš w w û 8%, 28%ƒ w š, w w 58.3%ƒ w šƒ 23-24). w

8 140 Jong-Gyu Kim, Jeong-Yeong Park, and Joong-Soon Kim w 0.9% 38%ƒ» w šƒ 11,26). š w» ù r ù w w.» w ù» w x ùküš. y» ew w»w ƒ. w w w { w /y v w š. ( ƒ, m,, m ) (52.9%) 6.9% eš ( ƒ ) (41.4%) ƒ. ¾ w ƒ û w ù w» w ƒƒ 55% 73.9%ƒ šƒ 11-12). w l ƒ, ƒ. ù w ƒ, m( ¾ ),,,, š q ¾ w «. z w w (60.8%) ƒ ù, { / k (37.9%) w ƒ ƒ š w (27.6%), š» l ü (27.6%)ƒ. š z { / k ƒ yw 11,12,24). z E. coli w, /k, k, š t t E. coliƒ ƒ û šƒ 28). w w w w ƒƒ 39.2% 5.9% ù w. w y œ š w w. y ƒ ƒ œ» w. ù w v w.» w z ƒ (52.9%) ƒ š, (41.4%) ƒ (34.5%), w ƒ» w ƒ w. Õ w / w» w { «ww. w t y z w ƒ «. x / ƒ v w. wr / w 16.7%ƒ w š w ù, w. w w w wš g š. w w 12) w 10% w ùkù w w. ƒ w y w w w š ƒ. (51.0%) w y š w ù, (97.4%)ƒ w y w. ü w š wš, š ùkü.» w q ƒ j. w t w, k w w k w û w 6). t w t w wš 63%ƒ w w w š w š 29). mw / w ƒ j y w. w w š ƒ w, š» w q ¾ š, w,» w q. t» z z» w Food Code» w š, 48% w. š ƒ 20» m w 30). t w, p w w w» w w. l t œ y w» g w»ƒ œ w. w w» w

9 A Study on the Hand Hygiene of Food Handlers of Food Court and Cafeteria in University Campus 141 /z l v w. x, ƒ ƒ. ƒ w ƒw ƒ.» l d, ù» d ww w. /z» w» wù, t»ƒ w. y z»ƒ š w ew. y s ³ wš z w w. y s ³ k, w»ƒ v w. y s ³ w³ w» w z t w ƒ w. w ƒ ³, ³, ³ ³ ƒ, s ³ ƒ w w ƒ ew š. S. aureus 15.7%, š 35.3%, z 7.8%, š 17.6% (data not shown). w t ƒ ³ S. aureus, 70% w šƒ 31). t xw S. aureus 23.1% šƒ 32). š w s ³ 2 t l l m (enterotoxin) w S. aureusƒ šƒ 33). w š m, t w» ³ / t w t y» w w. l, t» / w sƒ w v ƒ t v t w sƒ sww w. w ü {», š t š w. w w ü {,, š x ww. mw, y ƒ w w. x tœ ww. w» ƒ w. y z» / w,,,,,, š w ƒ (p < 0.05). w z ³, ³, ³ ³ ƒ û ùkû, w³ z s ³ sww. mw» ƒ, ³, ³, ³ y s ³» / w ƒ w y. { y w w w»ƒ wš t w z v w w. Ù 1. Walker, E., Pritchard, C. and Forsythe, S.: Food handlers' hygiene knowledge in small food businesses. Food Control, 14, (2003). 2. Restaineo, L. and Wind, C. E.: Antimicrobial effectiveness of hand washing for food establishments. Dairy, Food Environ. Sani, 10(3), (1990). 3. Michaels, B., Keller, C., Blevins, M., Paoli, G., Ruthman, T., Todd, E. and Griffith, C. J.: Prevention of food worker transmission of foodborne pathogens: risk assessment and evaluation of effective hygiene intervention strategies. Food Ser. Technol, 4, (2004). 4. Bryan, F. L.: Factors that contribute to outbreaks of foodborne disease. J. Food Prot, 41, (1978). 5. Acikel, C. H., Ogur, R., Yaren, H., Gocgeldi, E., Ucar, M. and Kir, T.: The hygiene training of food handlers at a teaching hospital. Food Control, 19, (2008). 6. Kim, J. G.: Studies on the food hygiene/safety knowledge, attitudes, and practices of kitchen employees in school foodservice programs-part 1. Kor. J. Environ. Health Soc, 30(2), (2004) (Korean). 7. Rainer, D.: Infectious disease outbreaks and hand washing and fire codes and hand sanitizers. J. Chem. Health Safety, 16(6), (2009). 8. Moe, C. L., Christmas, W. A., Echols, L. J. and Miller, S. E.: Outbreaks of acute gastroenteritis associated with Norwalk-like viruses in campus settings. J. Am. Coll. Health, 50, (2001). 9. Centers for Disease Control and Prevention: Stopping germs at home, work and school Available from: cdc.gov/germstopper/home_work_school.htm. Accessed Sep-

10 142 Jong-Gyu Kim, Jeong-Yeong Park, and Joong-Soon Kim tember 30, Center for Food Safety and Applied Nutrition, US Food and Drug Administration: Handwashing Available from: http :// Accessed September 30, Kim, J. G., Park, J. Y. and Kim, J. S.: A study on the hand-washing awareness and practices of male university students. J. Environ. Health Sci, 35(1), (2009) (Korean). 12. Kim, J. G. and Kim, J. S.: A study on the hand-washing awareness and practices of female university students. J. Food Hyg. Safety, 24(2), (2009) (Korean). 13. Green, L. R. and Selman, C: Factors impacting food worker's and managers' safe food preparation practices: a qualitative study. Food Prot. Trends, 25(12), (2005). 14. Paulson, D. E.: Evaluation of three microorganism recovery procedures used to determine hand wash efficacy. Dairy Food Environ. Sanit, 13, , Seal, L. and Paulson, D.: Antimicrobial persistence and residual effect in healthcare personnel handwashes. Am. J. Infect. Control, 32(3), E21-E22 (2004). 16. Dettol Available at: Korea Food and Drug Administration: Food Code of Korea (2009). 18. The Handwashing Coalition of Korea. Available from: Accessed March 30, Green, L. R., Selman, C. A., Radke, V., Ripley, D., Mack, J. C., Reimann, D. W., Stigger, T., Motsinger, M. and Bushnell, L.: Food worker hand washing practices: an observation study. J. Food Prot, 69(10), (2006). 20. CODEX. Codex Alimentarius. Rome: CODEX (1997). 21. American Society for Microbiology (ASM). Handwashing fact sheet Available from: Accessed September 30, Jeong, J. S., Choi, J. K., Jeong, I. S., Baek, K. R., In, H. K. and Park, K. D.: A nationwide survey on the hand washing behavior and awareness. J. Prev. Med. Public Health, 40(3), (2007) (Korean). 23. Guian, M. E., McGuckin-Guinan, M. and Sevareid, A.: Who washes hands after using the bathroom? Am. J. Infect. Control, 24, (1997). 24. Anderson, J. L., Warren, C. A., Perez, E., Louis, R. I., Phillips, S., Wheeler, J., Cole, M. and Misra, R.: Gender and ethnic differences in hand hygiene practices among college students, Am. J. Infect. Control, 36, (2008). 25. Johnson, H. D., Sholcosky, D., Ragni, R. and Ogonosky, N.: Sex differences in public restroom handwashing behavior associated with visual behavior prompts. Percept. Motor Skills, 97, (2003). 26. Drankiewicz, D. and Dundes, L.: Handwashing among female college students. Am. J.I nfect. Control, 31, (2003). 27. Scott, E. and Vanick, K.: A survey of hand hygiene practices on a residential college campus. Am. J. Infect. Control, 35, (2007). 28. Ansari, S. A., Springthorpe, V. S., Satter, S. A., Tostowaryk, W. and Wells, G. A.: Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands. Am. J. Infect. Control, 19(5), (1991). 29. Clayton, D. A., Griffith, C. J., Price, P. and Peters, A. C.: Food handlers' beliefs and self-reported practices. Int. J. Environ. Health Res, 12, (2002). 30. Allwood, P. B., Jenkins, T., Paulus, C., Johnson, L. and Hedberg, C. W.: Hand washing compliance among retail food establishment workers in Minnesota. J. Food Prot, 67(12), (2004). 31. Ayçiçek, H., Aydog o an, H., Küçükkaraaslan, A., Baysallar, M. and Bașustaog o lu, A. C.: Assessment of the bacterial contamination on hands of hospital food handlers. Food Control, 15, (2004). 32. Simsek, Z., Koruk, I., Copur, A. C. and Gürses, G.: Prevalence of Staphylococcus aureus and intestinal parasites among food handlers in Sanliurfa, Southeastern Anatolia. J. Public Health Manag. Pract, 15(6), (2009). 33. Wei, H. L. and Chiou, C. S.: Molecular subtyping of Staphylococcus aureus from an outbreak associated with a food handler. Epidemiol. Infect, 128(1), (2002).

Jeong-Ah Bang, Chui Im Choi, Wonho Choi, , and Dae Hong Jeong

Jeong-Ah Bang, Chui Im Choi, Wonho Choi, *, and Dae Hong Jeong* Journal of the Korean Chemical Society Printed in the Republic of Korea ƒ w x w w k w z : yw I Á Á y, *Á y* w yw š w (2006. 4. 26 ) The Effects of Science Inquiry Learning Applying Open- Ended Hypothesis-Testing